title: Trauma in the neighborhood: a geospatial analysis and assessment of social determinants of major injury in North America.
abstract: OBJECTIVE
  We sought to identify and characterize areas with high rates of major trauma events in 9 diverse cities and counties in the United States and Canada.
  
  
  METHODS
  We analyzed a prospective, population-based cohort of injured individuals evaluated by 163 emergency medical service agencies transporting patients to 177 hospitals across the study sites between December 2005 and April 2007. Locations of injuries were geocoded, aggregated by census tract, assessed for geospatial clustering, and matched to sociodemographic measures. Negative binomial models were used to evaluate population measures.
  
  
  RESULTS
  Emergency personnel evaluated 8786 major trauma patients, and data on 7326 of these patients were available for analysis. We identified 529 (13.7%) census tracts with a higher than expected incidence of major trauma events. In multivariable models, trauma events were associated with higher unemployment rates, larger percentages of non-White residents, smaller percentages of foreign-born residents, lower educational levels, smaller household sizes, younger age, and lower income levels.
  
  
  CONCLUSIONS
  Major trauma events tend to cluster in census tracts with distinct population characteristics, suggesting that social and contextual factors may play a role in the occurrence of significant injury events.
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA. newgardc@ohsu.edu
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: Robert H
authors.initials: RH
authors.lastname: Schmicker
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Dug
authors.initials: D
authors.lastname: Andrusiek
authors.forename: Walter
authors.initials: W
authors.lastname: Bialkowski
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Karen
authors.initials: K
authors.lastname: Brasel
authors.forename: Eileen
authors.initials: E
authors.lastname: Bulger
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Fleischman
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Kerby
authors.forename: Blair L
authors.initials: BL
authors.lastname: Bigham
authors.forename: Craig R
authors.initials: CR
authors.lastname: Warden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D011446:Prospective Studies; D012111:Residence Characteristics; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult